L4-HLTENN041_Ethical-concepts-relevant-to-nursing-practice_V2_2023_2_.txt

RMIT Classification: Trusted HLTENN041 Apply legal and ethical parameters to nursing practice NURS5420/5421C Lesson 4 Ethical concepts relevant to nursing practice RMIT Classification: Trusted SESSION OBJECTIVES By the end of this session, learners will be able Define Ethics and bioethics Discuss Nu...

RMIT Classification: Trusted HLTENN041 Apply legal and ethical parameters to nursing practice NURS5420/5421C Lesson 4 Ethical concepts relevant to nursing practice RMIT Classification: Trusted SESSION OBJECTIVES By the end of this session, learners will be able Define Ethics and bioethics Discuss Nursing ethics Identify the Human rights (Charter of Human rights) Discuss major ethical principles and apply these in nursing scenarios Recognise and discuss bioethical dilemmas Identify and discuss an ethical decision-making model Discuss Open disclosure process RMIT University©2017 School of Vocational Engineering, Health & Sciences RMIT Classification: Trusted WHAT ARE ETHICS? Ethics are defined as the moral principles that determine how a person or group of people will act or behave in specific situations. Ethics are not the laws, but these are an agreed standard of behaviour Standards of conduct and moral judgment Morals are personal - Formed from individual beliefs and experiences Professional - Nurses are required to uphold ethics 3 RMIT Classification: Trusted YOUR THOUGHTS? In our society, what common ethics do we abide by? What influences your ethical beliefs? 4 RMIT Classification: Trusted ETHICS Cornerstone of nursing profession. Strong ethics is vital as moral dilemmas can arise when attending to patients. It is essential for nurses to recognise ethical problems and apply the profession’s ethics and core values in judgement and decision making. 5 RMIT Classification: Trusted BIOETHICS Bioethics is the study of the ethical issues emerging from advances in biology and medicine. It is also moral discernment as it relates to medical policy and practice. Bioethics are concerned with the ethical questions that arise in the relationships among science, medicine and society. 6 RMIT Classification: Trusted BIOETHICS Moral vision, decisions, conduct and policies of the life sciences and health care. Rights & duties of patients & health professionals Rights & duties of research subjects & researchers Formulation of public policy for clinical care & biomedical research 7 RMIT Classification: Trusted ETHICS Consequentialist ethics Holds the view that the correct moral response is solely related to the outcome, or consequence, of the act. Deontological ethics It places value on the intentions of the individual (rather than the outcomes of any action) and focuses on rules, obligations and duties. Requires absolute adherence to these obligations and acting from duty is viewed as acting ethically. Virtue ethics Relate to the internalised moral characteristics, rational thought and practical wisdom of a virtuous person who possesses and lives the virtues. 8 NURSING ETHICS A set of ethical and moral standards which are directly in relation to the field of nursing. View ethical and How can we make bioethical issues in a decisions legally nursing perspective and ethically? Our standards of ethical conduct? 9 CAN YOU RECALL NURSES CODE OF ETHICS 4 Elements: Nurses and patients or other Outline the standards people requiring care or services of ethical conduct Nurses and practice Nurses and the profession Nurses and global health 4 Fundamental responsibilities to promote health to prevent illness to restore health to alleviate suffering and promote a dignified death. https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdf HUMAN RIGHTS What is your understanding about Universal human rights. What are they? Charter of Human rights and responsibilities Act 2006 (Effective in Victoria- 06/04/2020) Skim through the PART 2—HUMAN RIGHTS—what they are and when they may be limited. Share your findings. https://www.legislation.vic.gov.au/in-force/acts/charter-human-rights-and- responsibilities-act-2006/014 MAJOR ETHICAL PRINCIPLES Autonomy Beneficence Non-maleficence Justice Veracity Privacy and confidentiality AUTONOMY A person has a right to have an opinion and make decisions based on personal values and beliefs Self-determination Non-interference by others AUTONOMY Nurses have a responsibility to encourage the person (patient, client, resident) to exercise their autonomy whenever possible Nurses may need to advocate for the client Professional Patient has the right to accept or refuse treatments autonomy- a different concept to ethical principle of patient autonomy How is autonomy related to informed consent? PROFESSIONAL AUTONOMY Professional autonomy means having the authority to make decisions and the freedom to act in accordance with one’s professional knowledge base. This is based on: Professional Patient –based professional competence autonomy- a + different concept Self reliance to provide the best care plan for the promotion of to ethical principle patient’s health, of patient autonomy Through professional decision making and professional interactions with other professional team members BENEFICENCE ‘Above all, do good.’ An obligation to act for the benefit of others. Nursing actions that actively promote welfare and well-being of the patient Care, compassion, empathy, sympathy and kindness. Encouraging a patient to do their exercises, providing them their medications etc. NON-MALEFICENCE ‘Above all, do no harm’ Can include both the risk of harm and intentional harm Includes avoiding negligence in patient care Be aware of potential harms in any of your actions or inactions Avoiding unnecessary and unreasonable harm to patient like patient was given a medication to which they were allergic. BENEFICENCE VS NON- MALEFICENCE Obligation not to harm patient (non-maleficence) vs obligation to make a situation better by doing good (beneficence) Both principles are often two sides of the same coin Think about the following nursing action Giving an injection to a patient for pain relief JUSTICE Fairness/equality: No discrimination based on race, gender, religion etc. Equity: Equal distribution of resources Treatment must be given as per individual needs If a group of patients have same needs, then ensure equal time and cost Priority should be given to emergency/urgent needs VERACITY Telling the truth Trust relationship between the client/nurse A client’s right to know all important information concerning his/her well-being Breaches: Lying, withholding information, partial disclosure, deception How is veracity related to autonomy? Is it ever OK not to be completely honest? PRIVACY AND CONFIDENTIALITY The Privacy Act 1988 governs the manner in which ‘personal information’ is handled by Commonwealth agencies and organizations. Nationally consistent regulation of privacy and the handling of personal information. CONFIDENTIALITY: Specific restrictions upon private information revealed in confidence, with an understanding that the information will not be disclosed to others Code of conduct for nurse principle 3.5-confidentiality and privacy https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional- standards.aspx Case Study 1 A nurse posted the following comment on her social media page: “Can this shift be any longer? It started out with a waiting room full of nagging people that don’t seem to know what “emergency” means. Then I had to deal with the drama of trying to transfer a 190 kg. (no joke) intubated COPD patient down the hall to the ICU, those ICU nurses are such divas and I wasn’t in the mood for their whining. Anyone around ABC Hospital want to save me with a drink to get me through the next 10 hours of my shift???” If you read this post, would you be able to identify the client? Case Study 2 A nurse educator from a topical disease clinic is preparing a presentation poster for an infectious diseases conference. She includes pictures of varying stages of a client’s lesions in the poster. In this scenario, What does this nurse need to consider? Case Study 3 Marcus was admitted to the hospital from the long-term care facility. He was diagnosed with dehydration and delirium. He is expected to eventually return to the facility. The charge nurse at the facility calls for an update of Marcus’ status. Can the hospital nurse share this information with the long-term care facility? EXAMPLES OF NURSING ETHICS IN ACTION Common Ethical Dilemmas Respecting a patient’s personal healthcare decisions A decision that results in suboptimal care The nurse’s role in End-of-life decisions Sourced from: Nursing Ethics: Ethical Decision-Making for Nurse Leaders Ethical dilemmas for Nurses Informed consent – is patient sufficiently competent to consent Protecting patient’s rights Breaches of patient confidentiality Cultural competency and Nursing Ethics Sourced from: Nursing Ethics: Ethical Decision-Making for Nurse Leaders Scenario – Consent / Patient competency A 61-year-old woman was admitted to hospital with a fracture leg. Whilst in hospital a PAP smear test and biopsy revealed Stage 1 A carcinoma of the cervix. Surgery was strongly recommended as the cancer was curable by a hysterectomy. The patient refused surgery. The doctor felt she was cognitively incompetent, requesting neurological and psychiatric consultations to determine the possibility of dementia or mental incompetence. The psychiatrist felt the patient was cognitively incompetent, therefore unable to make decisions regarding her own care. This determination was based on the patient’s steadfast “unreasonable” refusal to undergo surgery. Scenario – Consent / Patient competency The neurologist disagreed with the finding of the psychiatrist. On questioning the patient stated she was refusing as she did not believe that she had cancer. “Everyone knows that people with cancer fell sick, have pain and lose weight,” she said. “I fell quite well.” Is she entitled to refuse the treatment? Does a competent person have the right to make an unreasonable decision? Is there an argument for overriding the patient’s refusal? Because of her belief, does this mean that her refusal is not informed? If the patient is competent, does it matter what path of reasoning led to her choice/decision? BIOETHICAL DILEMMA An ethical dilemma is one where there is a decision-making problem between two possible moral imperatives, neither of which is unambiguously acceptable or preferable. BIOETHICAL DILEMMA Abortion Euthanasia Do not resuscitate “DNR” What are the ethical issues here? BIOETHICAL DILEMMAs in Healthcare What are the ethical issues are associated with the following modern day treatments. Voluntary assisted dying Reproductive technology Tissue transplantation Organ donation Quality of life Conscientious objection BIOETHICAL DILEMMAs in Healthcare What are the ethical issues are associated with the following modern day treatments. Abuse Artificially prolonging life Stem cell research Refusal and withdrawal of treatment Cultural and religious matters How Ethics Affect Nursing? Decision making Moral distress – when patient requests or refusal of treatment are inconsistent with medical practice or patients interests Ethical approach – finding the solution that brings about optimal patient outcome Patient Safety and equity Understaffing and other issues that impact on nurses’ responsibility for patient safety Ethic approach – ensuring ethical and equitable care Sourced from: Nursing Ethics: Ethical Decision-Making for Nurse Leaders ETHICAL DECISION MAKING MODELS 1. Participative ethical decision making model (PEDM) – comprehensive approach that takes into consideration important ethical principles of nursing and involves seven questions to be answered during an ethical dilemma. 2. Kerridge’s model for ethical decision making – provide a multistep process for the purpose of reaching decisions in difficult clinical situations. KERRIDGE’S MODEL FOR ETHICAL DECISION MAKING Clearly state the problem Consider the problem within its context and attempt to distinguish between ethical problems and other medical, social cultural, linguistic and legal issues. Get the facts Find out as much as you can about he problem through history examination and relevant investigations. Take time to listen to the patient. Search the facts that you do not have. 3.Consider the fundamental ethical principles Consider autonomy, beneficence, non-maleficence, justice, confidentiality/privacy and veracity Consider how the problem would look from another perspective Identify ethical conflicts Explain how the ethical conflicts occur and how they might be resolved. 6. Consider the law Identify relevant legal concepts and laws and how they might guide management. Make the ethical decision Identify ethically viable options. Clearly make the ethical decision and justify it. How Ethics Shape a Nurse’s Daily Responsibilities Patient Safety Evidence - based practice Competency Person centred care Positive interpersonal behaviours Quality care Clinical leadership and governance Patient advocacy Sourced from: Nursing Ethics: Ethical Decision-Making for Nurse Leaders RESPONDING TO CONFLICTS OR COMPLAINTS Listen to the person making the complaint Record the details of the complaint Discuss solutions and options for fixing the problem Respond to client concerns promptly and follow up Use relevant decision making models and frameworks OPEN DISCLOSURE Open disclosure is an open discussion with a patient / consumer about an incident(s) that resulted in harm to that patient / consumer, while they were receiving health care. Open disclosure discussions also include the patient’s family, carer and/or support person https://www.safetyandquality.gov.au/sites/default/files/migrated/Australian- Open-Disclosure-Framework-Feb-2014.pdf OPEN DISCLOSURE The elements are: an expression of regret a factual explanation of what has happened an opportunity for the patient and significant others to relate their experience a discussion of potential consequences an explanation of the steps taken to manage the incident RMIT Classification: Trusted Open Disclosure The guiding principles of open disclosure framework Clear and timely communication Acknowledgement Apology or expression of regret Support and meeting the needs and expectations of individuals , their families and carers Support and meeting the needs and expectations of those providing the healthcare Integrated clinical risk management and systems improvement Good governance Confidentiality RMIT University©2017 School of Vocational Engineering, Health & Sciences RMIT Classification: Trusted Open Disclosure Scenario: Mrs S is an 86-year-old female patient admitted with Acute pulmonary oedema (APO) on the background of Congestive cardiac failure (CCF). Her current treatment includes diuresis with IV Frusemide 40mg (BD), 1.5L Fluid restrictions, Daily weight and Strict Fluid Balance chart. On commencement of their AM shift, the primary nurse goes to see Mrs S to take her vital signs and administer her morning medications. Mrs S was sitting in bed (Heas of bed 30) and c/o shortness of breath. On assessment, her RR= 38 with increased work of breathing, O2 saturations 86% on 2L O2 via NP. The nurse undertook the following actions: 1. Repositioned Mrs S to optimal position (Sat them upright in bed) 2. Adjusted O2 to 4L O2 via NP with O2 monitoring on 3. Referred to the patient’s medication chart and promptly administered PO Frusemide 40mg (AM dose) and PRN inhalers. 4. Rechecked pt’s Vital signs and escalated to call a MET call. RMIT University©2017 School of Vocational Engineering, Health & Sciences RMIT Classification: Trusted Open Disclosure During the MET Call, it was identified that the nurse had erroneously administered the Frusemide 40mg dose orally, instead of IV administration. Does open disclosure apply to this scenario. Who is responsible for open disclosure? How can you start the open disclosure process? Who will be present during open disclosure discussions? RMIT University©2017 School of Vocational Engineering, Health & Sciences SOME KEY TERMs HARM: impairment of structure or function of the body and/or any deleterious effect arising there from, including disease, injury, suffering, disability and death. Harm may be physical, social or psychological. (WHO) 46 SOME KEY TERMs INCIDENT: any event/circumstance which could have or did lead to unintended and /or unnecessary psychological or physical harm to a person/to a complaint, loss or damage during an episode of health care NEAR MISS: An incident that did not cause harm but had the potential to do so 47 RMIT Classification: Trusted SUMMARY The earlier nurses begin thinking about nursing ethics, the more aware they become of the importance of integrating ethics into all aspects of the nursing profession. RMIT Classification: Trusted This Photo by Unknown Author is licensed under CC BY-SA RMIT Classification: Trusted REFERENCES Staunton, P. (2017). Law for Nurses and Midwives. 8th ed. Sydney: Elsevier. Retrieved from: https://www-clinicalkey- com.ezproxy.lib.rmit.edu.au/student/nursing/content/toc/3-s2.0-C20150018792 Atkins, K De Lacey, S Britton, B. (2014). Ethics & the Law for Australian Nurses. 2nd ed. Melbourne: Cambridge University Press. Johnstone, M-J. (2009). Bioethics a nursing perspective. 5th ed. Sydney: Elsevier. www.legislation.vic.gov.au https://www.publicadvocate.vic.gov.au/ RMIT University©2017 School of Vocational Engineering, Health & Sciences REFERENCES Australian Commission on Safety and Quality in Healthcare, (2009). The Australian Charter of Healthcare Rights, a guide for health care providers. Retrieved from the Australian Commission on Safety and Quality and in health Care website: http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/17500-HealthCareguide.pdf Australian Nursing and Midwifery Council (2002). National Competency Standards for the Enrolled Nurse. Retrieved from the NMBA website: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx#competencystandards Kerridge, I., Lowe, M., & Stewart, C. (2011). Ethics and Law for the Health Professions. (3rd ed.). Sydney, Austraia: The Federation Press. Koutoukidis, G., Stainton, K., &Hughson, J. (2013). Tabbner’s Nursing Care Theory and Practice. (6th ed.). Chatswood, Australia: Elsevier. 51